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ED Form 646-1

OMB no 1845-0030
Expires 04/30/2004

Fiscal Operations Report and Application to Participate (FISAP)
Report: Award Period July 1, 2000 - June 30, 2001; Application: Award Period July 1, 2002 - June 30, 2003
Part I. Identifying Information, Certifications and Warning
Section A. Identifying Information
1a. Name and address of school

1b. Mailing address (if different from 1a)

________________________________________
_________________________________________
________________________________________

2a. Serial # ____________

3. Type of school (select one)
__ 3.1 public
__ 3.2 private/non-profit
__ 3.3 proprietary

_____________________________________
_____________________________________
_____________________________________

2b. OPEID # ________________

4. Length/type of longest program (select one)
__ 4.1 less than 1 year
__ 4.2 1 year but less than 2 years
__ 4.3 2 years but less than 3 years
__ 4.4 3 years but less than 4 years

__ a) art
__ d) trade & technical
__ b) business
__ e) other
__ c) cosmetology
5. Additional locations:
Schools with separately eligible additional locations which will
be funded under this application must list these locations and their
addresses and OPEID#'s on the screen. You may not file a separate
application for any separately eligible school listed herein.
6. Financial Aid Administrator
Typed Name ______________________________
E-mail address ___________________________

__ 4.5 4 years
(no higher than a
baccalaureate degree)
__ 4.6 5 years or more
__ 4.7 postbaccalaureate
only

We have entered a list of separately
eligible additional locations included
in this application.

yes
___

no
___

Telephone No. (____) _____ - _____
Fax No.
(____) _____ - _____

7. Name & address of private financial aid consultant firm, if any:
Name:
___________________________________
Address 1 ___________________________________
Address 2 ___________________________________
City: ____________________ State:____ Zip:___ _____

Section B.

Certifications and warning

Certifications Regarding Lobbying; Debarment, Suspension and Other Responsibility Matters; and Drug-Free Workplace Requirements
Applicants should review the regulations and the instructions for certification included in the regulations before completing this form. Signature of this
form provides for compliance with certification requirements under 34 CFR Part 82, "New Restrictions on Lobbying," and 34 CFR Part 85, "Governmentwide Debarment and Suspension (Nonprocurement) and Government-wide Requirements for Drug-Free Workplace (Grants)." The certifications shall be
treated as a material representation of fact upon which reliance will be placed when the Department of Education determines to award the covered
transaction, grant, or cooperative agreement.
1. Lobbying
As required by Section 1352, Title 31 of the U.S. Code, and implemented at 34 CFR Part 82, for persons entering into a grant or cooperative agreement
over $100,000, as defined at 34 CFR Part 82, Sections 82.105 and 82.110, the applicant certifies that:
(a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to
influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in
connection with the making of any Federal grant, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or
modification of any Federal grant or cooperative agreement;
(b) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or
employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this
Federal grant or cooperative agreement, the undersigned shall complete and submit Standard Form - LLL, "Disclosure Form to Report Lobbying," in
accordance with its instructions;
(c) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including
subgrants, contracts under grants and cooperative agreements, and subcontracts) and that all subrecipients shall certify and disclose accordingly.

School Name

Serial # _______________

2. Debarment, Suspension, and Other Responsibility Matters
As required by Executive Order 12549, Debarment and Suspension, and implemented at 34 CFR Part 85, for prospective participants in primary covered
transactions, as defined at 34 CFR Part 85, Sections 85.105 and 85.110—
A. The applicant certifies that it and its principals:
(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal
department or agency;
(b) Have not within a three-year period preceding this application been convicted of or had a civil judgement rendered against them for
commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction
or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification
or destruction of records, making false statements, or receiving stolen property;
(c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or local) with commission of any of
the offenses enumerated in paragraph (2)(b) of this certification; and
(d) Have not within a three-year period preceding this application had one or more public transaction (Federal, State, or local) terminated for cause or
default; and
B. Where the applicant is unable to certify to any of the statements in this certification, he or she shall attach an explanation to this application.
3. Drug-Free Workplace (Grantees Other Than Individuals)
As required by the Drug-Free Workplace Act of 1988, and implemented at 34 CFR Part 85, Subpart F, for grantees, as defined at 34 CFR Part 85,
Sections 85.605 and 85.610 -A. The applicant certifies that it will or will continue to provide a drug-free workplace by:
(a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is
prohibited in the grantee's workplace and specifying the actions that will be taken against employees for violation of such prohibition;
(b) Establishing an on-going drug-free awareness program to inform employees about:
(1) The dangers of drug abuse in the workplace;
(2) The grantee's policy of maintaining a drug-free workplace;
(3) Any available drug counseling, rehabilitation, and employee assistance programs; and
(4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace;
(c) Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement required by paragraph (a);
(d) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the grant, the employee will:
(1) Abide by the terms of the statement; and
(2) Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace no later than five calendar
days after such conviction;
(e) Notifying the agency, in writing, within 10 calendar days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving
actual notice of such conviction. Employers of convicted employees must provide notice, including position title, to: Director, Grants Policy and
Oversight Staff, U.S. Department of Education, 400 Maryland Avenue, S.W. (Room 3652, GSA Regional Office Building No. 3), Washington, DC
20202-4248. Notice shall include the identification number(s) of each affected grant;
(f) Taking one of the following actions, within 30 calendar days of receiving notice under subparagraph (d)(2), with respect to any employee who is so
convicted:
(1) Taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements of the Rehabilitation
Act of 1973, as amended; or
(2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal,
State, or local health, law enforcement, or other appropriate agency;
(g) Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (a), (b), (c), (d), (e), and (f).
B. The grantee may insert in the space provided below the site(s) for the performance of work done in connection with the specific grant:
Place of Performance (Street address. city, county, state, zip code)
______________________________________________________
______________________________________________________
______________________________________________________
Check [ ] if there are workplaces on file that are not identified here.
Drug-Free Workplace (Grantees Who Are Individuals)
As required by the Drug-Free Workplace Act of 1988, and implemented at 34 CFR Part 85, Subpart F, for grantees, as defined at 34 CFR Part 85,
Sections 85.605 and 85.610A. As a condition of the grant, I certify that I will not engage in the unlawful manufacture, distribution, dispensing, possession, or use of a controlled
substance in conducting any activity with the grant; and
B. If convicted of a criminal drug offense resulting from a violation occurring during the conduct of any grant activity, I will report the conviction, in
writing, within 10 calendar days of the conviction, to: Director, Grants Policy and Oversight Staff, Department of Education,

School Name

Serial # ____________________

400 Maryland Avenue, S.W. (Room 3652, GSA Regional Office Building No. 3), Washington, DC 20202-4248. Notice shall include the identification
number(s) of each affected grant.
I CERTIFY THAT MY SCHOOL WILL COMPLY WITH THE ABOVE CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND
OTHER RESPONSIBILITY MATTERS; AND DRUG-FREE WORKPLACE REQUIREMENTS. I FURTHER CERTIFY THAT THE INFORMATION
CONTAINED IN THIS ELECTRONIC FISAP IS IN COMPLIANCE WITH GOVERNING LEGISLATION AND REGULATIONS AND IS TRUE AND
ACCURATE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT ALL INFORMATION ASSOCIATED WITH THIS FISAP IS SUBJECT TO
AUDIT AND PROGRAM REVIEW BY REPRESENTATIVES OF THE SECRETARY OF EDUCATION.
WARNING: ANY PERSON WHO KNOWINGLY PROVIDES FALSE OR MISLEADING INFORMATION ON THIS FISAP WILL BE SUBJECT TO A FINE
OF UP TO $10,000 OR IMPRISONMENT OF UP TO 5 YEARS OR BOTH UNDER PROVISIONS OF THE UNITED STATES CRIMINAL CODE TITLE 18
SECTION 1001.

8. Chief Executive Officer (President, Chancellor, Owner, etc.)
Signature ______________________________
Typed Name ______________________________
Title
____________________________________
E-mail address ____________________________

Date signed _____________
Telephone No. (___) ____ - _____
Fax No.
(__ ) ____ - _____

A-1

ED Form 646-1
OMB no 1845-0030
Expires 04/30/2004

Application, Part II
Name of school: _____________________________________________________
State: __
Part II. Application to Participate for Award Year July 1, 2002 through June 30, 2003

Section A. Request for funds for the 2002-2003 Award Year

1. Federal Perkins Loan Level of Expenditures

$ _________

2. Federal Perkins Loan Federal Capital Contribution

$ _________

3. FSEOG Federal Funds

$ _________

4. FWS Federal Funds

$ _________

Section B. Federal Perkins Loan Program Liquidation Request
(Applies only to certain schools; see instructions)
5. My school wishes to discontinue participation
in the Federal Perkins Loan Program.
__ yes

__ no

Section C. Waiver Request for the Underuse of Funds
My school has returned more than 10 percent of its Federal
Perkins Loan, FSEOG, or FWS allocation for the 2000-2001 Award Year.
6. My school wishes to apply for a waiver of the penalty for
the underuse of funds and will provide a written explanation
of the circumstances on the additional information screen.
__ yes

__ no

DO NOT SEND THESE PAGES TO THE DEPARTMENT
A-2

ED Form 646-1
OMB no 1845-0030
Expires 04/30/2004
Application, Part II
Name of school: _____________________________________________________
State: __
Section D. Information on Enrollment
My school has a traditional calendar

___yes ___ no

Schools with a traditional calendar that had
2000-2001 enrollment, fill in Field 7

Schools with a non-traditional calendar that had
2000-2001 enrollment, fill in Fields 9 through 20
(a)
Continuing Students

(a)
Undergraduate

7. Total number of
students, 2000-2001

(b)
Graduate/Professional

_______

9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.

_______

Schools with a traditional calendar that did not have
2000-2001 enrollment, fill in Field 8
(a)
(b)
Undergraduate Graduate/Professional
8. Estimated number of
students, 2001-2002

_______

July 1, 2000
_______
August 1
_______
_______
September 1
October 1
_______
November 1
_______
December 1
_______
January1, 2001 _______
February 1
_______
March 1
_______
April 1
_______
May 1
_______
June 1, 2001
_______

Section E. Assessments and Expenditures

(a)
Undergraduate
$ _________
$ _________
$ _________

22. Total tuition and fees for the Award Year July 1, 2000 - June 30, 2001
23. Total Federal Pell Grant expenditures for the 2000-2001 Award Year
24. Total expended for State grants and scholarships made to undergraduates
for the Award Year July 1, 2000 to June 30 , 2001
Section F. Information on Eligible Aid Applicants for Award Year 2000-2001

(b)

(c)

Undergraduate/ Baccalaureate
Without
1st Professional
25. Students with an
"Automatic" Zero EFC

_______

Taxable & Untaxed Income
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.

$
0 - $ 2,999
$ 3,000 - $ 5,999
$ 6,000 - $ 8,999
$ 9,000 - $11,999
$12,000 - $14,999
$15,000 - $17,999
$18,000 - $23,999
$24,000 - $29,999
$30,000 - $35,999
$36,000 - $41,999
$42,000 - $47,999
$48,000 - $53,999
$54,000 - $59,999
$60,000 & over
T o t a l

I n d e p e n d e nt
(d)

Undergraduate/ Baccalaureate

With
Degree

Without
1st Professional

_______

_______

(e)

Graduate/
Professional

With
Degree
_______

_______

Taxable & Untaxed Income
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______

_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______

_______
21. TOTAL

Dependent
(a)

(b)
New Starts

_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______

$
0 - $ 999 _______
$ 1,000 - $ 1,999 _______
$ 2,000 - $ 2,999 _______
$ 3,000 - $ 3,999 _______
$ 4,000 - $ 4,999 _______
$ 5,000 - $ 5,999 _______
$ 6,000 - $ 7,999 _______
$ 8,000 - $ 9,999 _______
$10,000 - $11,999 _______
$12,000 - $13,999 _______
$14,000 - $15,999 _______
$16,000 - $17,999 _______
$18,000 - $19,999 _______
$20,000 & over
_______
To t a l
_______

_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______

_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______

DO NOT SEND THESE PAGES TO THE DEPARTMENT
A-3

_______

_______

(b)
Graduate/Professional
$ _________

Ed form 646-1
OMB no 1845-0030
Expires 04/30/2004
Fiscal Operations Report, Part III
Name of school: _____________________________________________________
State: __
Part III. Federal Perkins Loan Program
Section A. - Fiscal Report (cumulative) as of June 30, 2001
Field

1.1
1.2
2
3
4
5
6

Item

Amount
(a)

Cash on hand and in depository as of 6/30/2001
Cash on hand and in depository as of 10/31/2001
$ _________
Funds receivable from Federal government
Funds receivable from school
Funds advanced to students
Loan principal collected
Loan principal assigned to and accepted by the United States
Loan principal canceled:
7
- for teaching/military service on loans made prior to 07/01/1972
8
- for certain subject matter teaching service (math, science,
foreign languages, bilingual education)
9
- for all other authorized teaching service
10
- for military service on loans made 07/01/1972 and after
11
- for volunteer service
12
- for law enforcement and corrections officer service
13
- for child/family/early intervention service
14
- for nurse/medical technician service
15
- for death/disability
16
- for bankruptcy
17
- for loans discharged due to closed schools
18 Loan principal adjustments - other
19 Federal Capital Contributions
20 Repayments of fund capital to Federal government
21 Institutional Capital Contributions
22 Repayments of fund capital to school
23 Interest income on loans
24 Other income
25 Reimbursements to the Fund of amounts canceled on loans
made 07/01/1972 and after
26.1 Administrative cost allowance
$ _________
26.2 Collection costs
$ _________
26.3 Administrative cost allowance and collection costs (control)
Cost of loan principal and interest canceled:
27
- for teaching/military service on loans made prior to 07/01/1972
28
- for certain subject matter teaching service (math, science, foreign
languages, bilingual education)
29
- for all other authorized teaching service on loans made 07/01/1972
and after
30
- for military service on loans made 07/01/1972 and after
31
- for volunteer service in the Peace Corps or under the Domestic
Volunteer Service Act of 1973
32
- for law enforcement and corrections officer service
33
- for child/family/early intervention service
34
- for nurse/medical technician service
35
- because of death/disability
36
- because of bankruptcy
37 Cost of loan principal and interest assigned to and
accepted by the United States
38 Cost of loan principal and interest canceled for loans discharged due to
closed schools
39 Other costs or losses
40 Total debits and credits (sum of Fields 1.1 through 39)

No of Borrowers Debit Balances Credit Balances
(b)
(c)
(d)

$ _________

_______
_______
_______

$ _________
$ _________
$ _________
$ _________
$ _________

_______
_______

$ _________
$ _________

_______
_______
_______
_______
_______
_______
_______
_______
_______
_______

$
$
$
$
$
$
$
$
$
$
$

_________
_________
_________
_________
_________
_________
_________
_________
_________
_________
_________

$ _________
$ _________
$ _________
$ _________
$ _________
$ _________

$ _________
$ _________
$ _________
$ _________
$ _________
$ _________
$
$
$
$
$
$

_________
_________
_________
_________
_________
_________

$ _________
$ _________
$ _________

DO NOT SEND THESE PAGES TO THE DEPARTMENT
A-4

$_________

ED Form 646-1
OMB no 1845-0030
Expires 04/30/2004
Fiscal Operations Report, Part III
Name of school: _____________________________________________________
State: __

Section B. Fund Activity (annual) during the 2000-2001 Award Year (July 1, 2000 through June 30, 2001)
Amount

1. Final adjusted Federal Capital Contribution (FCC) authorization

$ _________

2. FCC transferred to:
a. FSEOG
b. FWS

$ _________
$ _________

3. The unexpended amount of final adjusted authorized Federal Capital Contribution
for Award Year 2000-2001 that was not requested from GAPS by
June 30, 2001. This amount will be reduced from your total award amount
next Spring (see instructions) .

$ __________

4. Institutional Capital Contribution (ICC) deposited into the
Fund between July 1, 2000 and June 30, 2001.

$ _________

5. Loans advanced to students from the Fund during the 2000-2001
Award Year (minus 2000-2001 Award Year refunds)

$ _________

6. Administrative cost allowance claimed for the 2000-2001 award
year (see instructions)

$ _________

7. Total principal and interest repaid by borrowers
from all sources during the 2000-2001 Award Year

Number of
Borrowers
(a)

Amount
(b)

_______

$ _________

DO NOT SEND THESE PAGES TO THE DEPARTMENT
A-5

ED Form 646-1
OMB no 1845-0030
Expires 04/30/2004
Fiscal Operations Report, Part III
Name of school: _____________________________________________________
State: __
Section C - Cumulative Repayment Information as of June 30, 2001
Principal
Status of borrowers as of June 30, 2001

Amount
(a)

1.1
1.2

Borrowers whose loans are fully retired
Loans that have been purchased

2.

Number of
Borrowers
(b)

Amount
Amount Lent
(c)

Outstanding
(d)

__________

_____________

Borrowers whose loans were assigned to and
officially accepted by the Department of
Education as of June 30, 2001

__________

_____________

3.

Total borrowers not in repayment status

__________

_____________

4.

Borrowers on schedule in repayment status

__________

_____________

5.1

In default less than 240 days (monthly installments) or less than 270 days (other installments)

__________

_____________

_____________

5.2

In default 240 days or more (monthly installments) or 270 days or more (other installments),
up to 2 years

__________

_____________

_____________

5.3

In default more than 2 years, up to 5 years

__________

_____________

_____________

5.4

In default more than 5 years

__________

_____________

_____________

$_______
_____________

Cohort Default Rate
My school had less than 30 borrowers who entered
repayment in the 1999-2000 Award Year

___ yes

____ no

Section D. Schools with 30 or more borrowers who entered repayment in the 1999-2000 Award Year:
1.1 Number of borrowers who entered repayment in 1999-2000

__________

1.2 Enter the number of borrowers in Field 1.1 above with loans in default by June 30, 2001

__________

1.3 Cohort default rate (Field 1.2 / Field 1.1 * 100)

__________

Section E. Schools with less than 30 borrowers who entered repayment in the 1999-2000 Award Year:
2.1 Number of borrowers who entered repayment in:
(a) 1997-1998 (07/01/1997 - 06/30/1998) ________
(b) 1998-1999 (07/01/1998 - 06/30/1999) ________
(c) 1999-2000 (07/01/1999 - 06/30/2000) ________

2.2 Number of borrowers with loans in default by:
(a) June 30, 1999 (those in 2.1(a) only)
(b) June 30, 2000 (those in 2.1(b) only)
(c) June 30, 2001 (those in 2.1(c) only)

_________
_________
_________

2.3 Total number of borrowers who entered repayment during the three years (Fields 2.1(a) + 2.1(b) + 2.1(c))

___________

2.4 Total number of borrowers with loans in default (Fields 2.2(a) + 2.2(b) + 2.2(c))

___________

2.5 Cohort default rate (Field 2.4 / Field 2.3 * 100)

___________

DO NOT SEND THESE PAGES TO THE DEPARTMENT
A-6

ED Form 646-1
OMB no 1845-0030
Expires 04/30/2004
Fiscal Operations Report, Part IV
Name of school: _____________________________________________________
State: __
Part IV. Federal Supplemental Educational Opportunity Grant (FSEOG) Program
for Award Year July 1, 2000 through June 30, 2001
Section A. Federal funds authorized for FSEOG
1. Final adjusted FSEOG authorization

$ _________

Section B. Federal funds available for FSEOG expenditures
2. FWS funds transferred to and spent in FSEOG

+

$ _________

3. Federal Perkins FCC funds transferred to
and spent in FSEOG

+

$ _________

4. 2001-2002 funds carried back and spent in 2000-2001

+

$ _________

5. Additional 2001-2002 funds carried back and spent for
2001 summer enrollment

+

$ _________

6. 1999-2000 funds carried forward and spent in 2000-2001

+

$ __________

7. 2000-2001 funds carried forward to be spent in 2001-2002

-

$ __________

8. 2000-2001 funds carried back and spent in 1999-2000

-

$ __________

9. Additional 2000-2001 funds carried back and spent for
2000 summer enrollment

-

$ __________

10. Total Federal funds available for 2000-2001 FSEOG
(Fields 1 + 2 + 3 + 4 + 5 + 6 - 7 - 8 - 9)

$ _________

Section C. Funds to FSEOG recipients
11. Total funds to FSEOG recipients (Fields 12 + 13)

$ _________

12. Non-Federal share of funds to FSEOG recipients
(25% of Field 11)

$ _________

a. Cash outlay contributed
b. Other school resources designated

$ _________
$ _________

Section D. Federal funds spent for FSEOG Program
13. Federal share of funds to FSEOG recipients
(75% of Field 11)
14. Administrative cost allowance claimed

$ _________

+

$ _________

15. Federal funds spent for FSEOG (Fields 13 + 14)

$ _________

Section E. Use of FSEOG authorization
16. Expended FSEOG authorization (Fields 7 + 8 + 9 +15) minus
(Fields 2 + 3 + 4 + 5 +6)

$ _________

17. Unexpended FSEOG authorization (Field 1 - Field 16)
(cannot be negative)

$ _________

DO NOT SEND THESE PAGES TO THE DEPARTMENT
A-7

ED Form 646-1
OMB no 1845-0030
Expires 04/30/2004
Fiscal Operations Report, Part V
Name of school: _____________________________________________________
State: __
Part V. Federal Work-Study (FWS) Program for Award Year July 1, 2000 through June 30, 2001
Section A. Federal funds authorized for FWS
1. Final adjusted FWS authorization

$ _________

Section B. Federal funds available for FWS expenditures
2. Federal Perkins FCC funds transferred to and spent in FWS

+

$ _________

3. FWS funds transferred to and spent in FSEOG

-

$ _________

4. 2001-2002 funds carried back and spent in 2000-2001

+

$ _________

5. Additional 2001-2002 funds carried back and spent for
2001 summer employment

+

$ _________

6. 1999-2000 funds carried forward and spent in 2000-2001

+

$ _________

7. 2000-2001 funds carried forward to be spent in 2001-2002

-

$ _________

8. 2000-2001 funds carried back and spent in 1999-2000

-

$ _________

9. Additional 2000-2001 funds carried back and spent for
2000 summer employment/

-

$ _________

10. Total Federal funds available for 2000-2001 FWS
(Fields 1 + 2 - 3 + 4 + 5 + 6 - 7 - 8 - 9)

$ _________

Section C. Total compensation for FWS
11. Total earned compensation for FWS Program
a. On-campus expenditures
b. Off-campus expenditures at public or private non-profit agencies
c. Off-campus expenditures in the private (for profit) sector

$ _________
$ _________
$ _________
$ _________

12. Total school share of earned compensation (see instructions)

$ _________

Section D. Funds spent from Federal share of FWS
13. Total Federal share of FWS earned compensation
a. .Compensation at Federal share not to exceed 75%
(see instructions)
b. Off-campus private (for profit) sector compensation at Federal
share not to exceed 50%

$ _________
$ _________
$ _________

14. Administrative cost allowance claimed

+

$ _________

15. Federal share of Job Location and Development Program expenditures

+

$ _________

16. Total Federal funds spent for FWS (sum of Fields 13 through 15)

DO NOT SEND THESE PAGES TO THE DEPARTMENT
A-8

$ _________

ED Form 646-1
OMB no 1845-0030
Expires 04/30/2004
Fiscal Operations Report, Part V
Name of school: _____________________________________________________
State: __
Section E. Use of FWS authorization
17. Expended FWS authorization (Fields 3 + 7 + 8 + 9 + 16) minus (Fields 2 + 4 + 5 + 6)

$ _________

18. Unexpended FWS authorization (Field 1 - Field 17)

$ _________

Section F. Information about the Job Location and Development (JLD) Program
19. Total expenditures for the JLD Program

$ _________

20. School expenditures for the JLD Program (see instructions)

$ _________

21. Number of students for whom jobs were located or developed
22. Total earnings of the students in Field 21 above

_________
$ _________

Section G. Information about FWS students employed in community service activities
23. Number of students in community service employment

_________

24. Federal share of community service earned compensation

$ _________

25. Non-Federal share of community service earned compensation

$ _________

Section H. Information about FWS students employed as reading tutors of children or
employed in family literacy activities
26. Number of FWS students employed as reading tutors of
children or employed in family literacy activities
27 Federal share of earned compensation for FWS students employed
as reading tutors of children or employed in family literacy activities
a.

Amount of the Federal share in field 27 spent on community
service employment

28. Total earned compensation for FWS students employed as reading
tutors of children or employed in family literacy activities

_________

$

_________

$

_________

$ __________

Section I. Information about FWS students employed as mathematics tutors of children
29. Number of FWS students employed as mathematics tutors of children

__________

30. Federal share of earned compensation for FWS students employed as
mathematics tutors of children

$ __________

31. Total earned compensation for FWS students employed as mathematics
tutors of children

$ _________

DO NOT SEND THESE PAGES TO THE DEPARTMENT
A-9

ED Form 646-1
OMB no 1845-0030
Expires 04/30/2004
Fiscal Operations Report, Part VI
Name of school: _____________________________________________________
State: __
Part VI. Program Summary for Award Year July 1, 2000 through June 30, 2001

Section A. Distribution of program recipients and expenditures by type of student

Taxable & Untaxed
Federal Perkins Loan
FSEOG
Income Category
(a)
(b)
(c)
(d)
Student Type
Recipients
Funds
Recipients
Funds
Undergraduate Dependent

1. $

0-

FWS
(e)
(f)
Recipients Funds

(g)
Unduplicated
Recipients

$ 5,999

_______

_________

________

_________

_______

_________

________

2. $ 6,000 - $11,999

_______

_________

________

_________

_______

_________

________

3. $12,000 - $23,999

_______

_________

________

_________

_______

_________

________

4. $24,000 - $29,999

_______

_________

________

_________

_______

_________

________

5. $30,000 - $41,999

_______

_________

________

_________

_______

_________

________

6. $42,000 - $59,999

_______

_________

________

_________

_______

_________

________

7. $60,000 and over

_______

_________

________

_________

_______

_________

________

Undergraduate Independent
8. $

0-

$ 1,999

_______

_________

________

_________

_______

_________

________

9. $ 2,000 - $ 3,999

_______

_________

________

_________

_______

_________

________

10. $ 4,000 - $ 7,999

_______

_________

________

_________

_______

_________

________

11. $ 8,000 - $11,999

_______

_________

________

12. $12,000 -$15,999

_______

_________

________

13. $16,000 -$19,999

_______

_________

________

14. $20,000 and over

_______

15. Graduate/Professional
16. T o t a l

_______

_______

17. Total less than full time _______
students
18. Total "Automatic" Zero _______
EFC students

_________
_________
_________
_________

_________

_________

_______

_________

________

_________

_______

_________

________

_________

_______

_________

________

________

_________

does not
does not
apply
apply
________ _________
________

________

_________

_________

_______

_________

________

_______

_________

________

_______
_______

_______

_________
_________

________
________

_________

DO NOT SEND THESE PAGES TO THE DEPARTMENT
A-10

________

ED Form 646-1
OMB no 1845-0030
Expires 04/30/2004
Fiscal Operations Report, Part VI
Name of school: _____________________________________________________
State: __
Administrative Cost Allowance Worksheet (worksheet must be retained for audit and program reviews)
Section B. Calculating the administrative cost allowance
Step 1 Calculate the amount spent in 2000-2001 on which the administrative cost allowance is based:
1. Total compensation in FWS (amount from Part V, Section C, Field 11)
2. Amount of Federal Perkins Loan funds advanced to students
(amount from Part III, Section B, Field 5)
3. Total funds to FSEOG recipients
(amount from Part IV, Section C, Field 11)
4. Total amount spent (Fields 1 + 2 + 3)

$ ______
+

$ ______

+

$ ______
$ ______

Step 2 Calculate the administrative cost allowance
Schools whose total amount spent was $2,750,000 or less
5. Enter total amount spent (Field 4)
6. Multiply
7. Total administrative cost allowance
(go to step 3)

$ ______
x 0.05
$ ______

Schools whose total amount spent was more than $2,750,000 but less than $5,500,000
8. Enter total amount spent (Field 4)
9. Subtract
10. Expenditures over $2,750,000 (Field 8 - Field 9)
11. Multiply
12. Administrative cost allowance on expenditures over
$2,750,000 (Field 10 x Field 11)
13. Add administrative cost allowance on expenditures of
$2,750,000
14. Total administrative cost allowance (Field 12 + Field 13)
(go to step 3)
Schools whose total amount spent was $5,500,000 or more
15. Enter total amount spent (Field 4)
16. Subtract
17. Expenditures over $5,500,000 (Field 15 - Field 16)
18. Multiply
19. Administrative cost allowance on expenditures over
$5,500,000 (Field 17 x Field 18)
20. Add administrative cost allowance on expenditures
of $5,500,000
21. Total administrative cost allowance (Field 19 + Field 20)
(go to step 3)

x

+

$ n/a
$ 2,750,000
$ n/a
0.04
$ n/a
$ 137,500
$ n/a

$
$
$
x
$

-

+

n/a
5,500,000
n/a
0.03
n/a

$ 247,500
$ n/a

Step 3 Decide how much administrative cost allowance the school claimed:
22. How much administrative cost did the school claim
(the amount may be the same or less than the amount calculated in step 2)

$ ______

23. How much administrative cost did the school claim in each Program ?
a. Federal Perkins Loan (must be same as Part III, Sect. B, Field 6)
b. FSEOG (must be the same as Part IV, Section D, Field 14)
c. FWS (must be the same as Part V, Section D, Field 14)

DO NOT SEND THESE PAGES TO THE DEPARTMENT
A-11

$ ______
$ ______
$ ______

ED Form 646-1
OMB no 1845-0030
Expires 04/30/2004
Fiscal Operations Report
Name of school: _____________________________________________________
State: __
Additional information page for Fiscal Operations Report 2000-2001 and Application to Participate for 2002-2003
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DO NOT SEND THESE PAGES TO THE DEPARTMENT
A-12